Quality Improvement Facilitator III - Medicare Stars

About the role

Reporting to the Director, Medicare Stars, the Quality Improvement (QI) Facilitator III – Medicare Stars serves as a Medicare Stars regulatory and operational subject matter expert, ensuring Medicare-related quality improvement functions align with CMS regulations, CMS Star Ratings Program requirements, the Medicare Managed Care Manual, audit protocols, evolving CMS guidance, and IEHP organizational policies. This role independently leads and oversees complex Medicare Stars quality initiatives involving the prioritization of resource utilization, delegation of project deliverables, and application of quality concepts and standards to ensure improvements in organizational performance. This position translates CMS expectations into actionable workflows across operational, clinical, and provider facing teams. The QI Facilitator III facilitates Stars driven organizational improvement by applying improvement methodologies, managing cross functional project deliverables, and aligning initiatives with IEHP’s strategic goals for sustained Stars performance excellence.

Responsibilities

• Lead and oversee complex Medicare Stars quality initiatives, prioritizing resource utilization and delegating project deliverables.
• Apply quality concepts and standards to improve organizational performance.
• Translate CMS expectations into actionable workflows for operational, clinical, and provider‑facing teams.
• Facilitate Stars‑driven organizational improvement using improvement methodologies.
• Manage cross‑functional project deliverables and align initiatives with IEHP’s strategic goals.
• Support commitment to Quality Program goals including HEDIS, CAHPS, and NCQA Accreditation.

Requirements

• Minimum of six (6) years demonstrated professional‑level experience in process/project management, including participation in quality improvement projects or operations.
• Prior experience in a health care setting required.
• Prior experience designing Medicare Star Measure interventions preferred.
• Demonstrated experience increasing Plan Star Ratings through targeted quality improvement activities preferred.
• Knowledge of Risk Adjustment calculations and financial analysis related to Medicare Advantage membership populations preferred.
• Master’s degree in public health, health administration, public administration, or other healthcare‑related focus from an accredited institution required.
• Project Management Professional (PMP) Certificate, Certified Professional of Healthcare Quality (CPHQ), or other recognized quality improvement certificate required, or successful completion within one (1) year of hire.

Key Qualifications

• Valid California Driver’s license.
• Advanced knowledge and in‑depth understanding of healthcare quality performance and measurement sets including CMS quality withhold, NCQA Quality Improvement Standards and HEDIS.
• Project management techniques, tools of continuous improvement, and work process redesign.
• Standardized QI concepts.
• Standard coding sets used in quality measurement including ICD‑10, CPT, CPT Category II, HCPCS, LOINC, NDC.
• Strongly preferred advanced knowledge of Risk Adjustment calculations and financial analysis related to Medicare Advantage membership populations.
• Preferred understanding of CMS quality programs, Medicare Star Ratings methodology, HEDIS, CAHPS, Pharmacy Part D measures, NCQA standards, Risk Adjustment basics, and regulatory documentation requirements.
• Experience supporting CMS audits, data validation reviews, or compliance reporting.
• Familiarity with Medicare Managed Care Manual, HPMS guidance, and CMS regulatory updates.
• Advanced proficiency in analytical and critical thinking skills.
• Advanced proficiency in all Microsoft Office applications, with emphasis on Excel, PowerPoint, and Visio.
• Communication skills (verbal, written, listening) with ability to interact effectively and demonstrated comfort with public speaking to varied audiences.
• Ability to apply facilitation techniques to quality improvement project teams to achieve optimal outcomes.
• Problem solving, leadership qualities, conflict management, and team building skills to ensure a productive work environment and achievement of quality goals.
• Experience working with and motivating diverse teams including group process facilitation, change management and conflict resolution.
• Ability to teach quality improvement concepts and principles.
• Demonstrated ability to increase Quality Ratings through targeted quality improvement activities.
• Ability to read and interpret data.
• Results‑ and outcome‑oriented.
• Ability to perform complex tasks, prioritize multiple projects and work under pressure to meet deadlines in a fast‑paced environment.
• Demonstrate excellent project and time management skills.
• Exhibit high attention to detail.

Benefits

• Competitive salary
• State‑of‑the‑art fitness center on‑site
• Medical Insurance with Dental and Vision
• Life, short‑term,